A suspected overdose in the centre of London was another reminder Tuesday of a deadly crisis that has emergency crews regularly racing to save people without any vital signs on city streets.

Paramedics responded to a medical emergency shortly after 1 p.m. Tuesday near the corner of Richmond and Dundas streets, the heart of downtown. Bystanders described the incident involving a man as “a really bad overdose.”

Fentanyl, a potent, lab-made drug 100 times more powerful than morphine, can be bought on its own and used by the maker of street drugs to increase potency. It can turn up in other drugs without any warning, putting users at extreme risk.

“These days, more often than not, no matter what opioids you’re purchasing, unless it’s from a pharmacy, there’s probably fentanyl,” Mackie said.

In the London area, there were 42 opioid-related deaths between January and October 2018.

Opioids are highly addictive painkillers, also called narcotics, made from opium poppies or synthesized in a lab.

There are many different kinds of prescription and illicit opioids with varying strengths, including morphine, heroin, hydromorphone, oxycodone and fentanyl.

Prescription opioids such as OxyContin can be abused by patients or diverted to the streets, where they may be smoked, crushed and snorted or injected by drug users.

Opioids have been implicated in more than 2,000 deaths nationwide in the first half of 2018 alone.

In the London area, there were 42 opioid-related deaths between January and October 2018.

WHAT IS FENTANYL?

Fentanyl is a hyper-potent, lab-made opioid 100 times more powerful than morphine. As little as two milligrams of the drug, the equivalent of about four grains of salt, can kill a first-time user. It easily can be mixed into other drugs and is difficult to detect.

HOW DOES FENTANYL GET ON OUR STREETS?

Prescription gel fentanyl patches used to manage severe chronic pain can be sold on the streets, where the drug is smoked, ingested or dried into a powder.

Illegal powdered fentanyl, made in overseas labs and smuggled into Canada, can be cut into other drugs or pressed into tablets made to look like prescription pills.

Sometimes drug users end up with fentanyl accidentally when it’s cut into another drug they want. Other times they seek it out, said Ken Lee, lead physician at Canadian Mental Health Association Middlesex’s addiction medicine clinic. It’s powerful and cheaper, he said. “The people I see know that they’re using fentanyl,” Lee said. His patients report pharmaceutical-grade hydromorphone goes for $60 a point, one-tenth of a gram, on the street. “A point of fentanyl is much stronger and will last a lot longer. It’s cheaper than buying the known pharmaceutical-grade pills,” Lee said.

WHAT MAKES FENTANYL USEFUL TO DRUG DEALERS?

Non-users might wonder, why mix in a drug that could kill your customers? For dealers, the benefit is that slipping fentanyl into another kind of illegal drug can increase the high buyers get from using it, and mixing in fentanyl also lets dealers stretch out their supply of the more expensive drugs — say, heroin — that they’re selling.

NOT ALL FENTANYL IS CREATED EQUAL

Fentanyl made in clandestine labs can vary batch by batch, Lee said. It can be weak or very strong and can contain fentanyl relatives including carfentanil — an elephant tranquilizer that’s 10,000 times stronger than morphine — mixed in. Some officials have wondered if a recent rash of Southwestern Ontario overdoses, both fatal and non-fatal, may be the result of a “toxic” batch of fentanyl hitting the region.

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